Provider Demographics
NPI:1043241318
Name:RIVER VIEW IMAGING CENTER LLC
Entity Type:Organization
Organization Name:RIVER VIEW IMAGING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP AMB SVCS,IMAGING BOARD PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:K
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-546-4303
Mailing Address - Street 1:2405 N COLUMBUS ST
Mailing Address - Street 2:SUITE 180
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8185
Mailing Address - Country:US
Mailing Address - Phone:740-681-5661
Mailing Address - Fax:740-689-9925
Practice Address - Street 1:2405 N COLUMBUS ST
Practice Address - Street 2:SUITE 180
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8185
Practice Address - Country:US
Practice Address - Phone:740-681-5661
Practice Address - Fax:740-689-9925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0447IC261QM1200X, 261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2098528Medicaid
OH2098528Medicaid